From a public health perspective, some social norms are beneficial (eg, washing your hands), while others are less so (eg, shaking hands, which may spread germs). Social norms can encourage or discourage violence. For example, traditional norms that men have a right to control women and that sexual violence is a private affair increase the likelihood of intimate partner violence. Social norms that encourage violence can be changed.

Keeping Children Away From Unsecured Firearms

About one-third of homes with children have guns, with many guns stored unsafely. Some 1500 to 3000 children 17 years or younger are treated in hospital emergency departments for unintentional firearm injuries each year, and more than 100 die. When a child is killed, most often the mishap is at the hands of a brother or friend. To reduce the problem, The Center to Prevent Youth Violence, in collaboration with the American Academy of Pediatrics, created the ASK (Asking Saves Kids) campaign.1

Just as parents may ask the parents of the children their children visit about seat belts or pool safety, they can also ask about firearms and their accessibility. Asking can help keep one’s own children and their friends safe and also help to promote the social norm of safe gun storage in the community. An evaluation in which I participated found that the ASK campaign was somewhat successful in changing attitudes and that few parents minded being asked.2

Physicians help change social norms. The American Academy of Pediatrics has determined that a gun in the home is a danger to children, and those families that have a gun should store it properly. Unfortunately, Florida has enacted a law making it difficult for physicians to determine the firearm status in the home, prohibiting them from asking patients whether they own guns and, if so, how the firearms are stored. Other states are considering similar legislation.

Reducing Gun Trafficking

Reducing gun trafficking involves increasing awareness of where guns come from and preventing the purchase of guns by people who cannot legally do so. When the media report on deadly motor vehicle crashes, they often describe seat belt use and whether alcohol was involved. Such reporting provides a continual reminder of social norms—norms that were quite different 25 years ago. Now seat belt use is expected, and drinking and driving is verboten.

A Boston nonprofit organization, Citizens for Safety (I am on the board of directors), is encouraging reporters (and the general public) to ask, whenever there is a street shooting, “Where did the gun come from?”3 In most street shootings, there are 2 crimes: the shooting itself and an earlier (usually) criminal transaction that armed the shooter. Boston gang members are not born with guns; their parents rarely own guns; and they cannot easily obtain guns through burglary, since few Bostonians own guns. Often an adult has made money bringing guns into the inner city.

The Where Did the Gun Come From? campaign is designed to expand awareness beyond the shooter and victim to the system of gun trafficking, where additional programs and policies can make a difference. This expanded focus has given the community a meaningful way to try to reduce firearm violence.

There are many ways to reduce “straw purchasing”—the buying of a firearm for someone who cannot legally obtain one. Similar to the purchase of alcohol and cigarettes for people who are underage, it can be the social norm, as well as the legal requirement, that retailers use effective practices and procedures to reduce straw purchasing (eg, employee training, transaction videotaping).

Campaigns can focus on the straw buyer (eg, “Don’t Lie for the Other Guy”). Although most straw purchasers are men, emerging research finds that women are disproportionately buying and holding guns for felons who cannot obtain guns legally. A new initiative tries to reduce the willingness of women to engage in straw purchasing using peer-to-peer education and leadership development. As women have helped reduce drunk and reckless driving by men, women can mobilize to help reduce firearm violence.3

Reducing Suicide

Although few people attempt suicide with a gun, more than half of all suicide deaths in the United States are gun suicides. Some 2 dozen US studies have found that access to a firearm is a strong risk factor for suicide. Firearm owners are not more suicidal than other people; rather, their suicide attempts are more likely to be completed.4

Suicide attempts often occur with little planning during a period of short-term crisis. If highly lethal means are made less available to people who attempt suicide impulsively, their odds of surviving an attempt increase. Over 90% of people who survive a suicide attempt do not go on to die by suicide. Studies show that when access to a highly lethal and leading suicide method is reduced, the overall suicide rate drops—driven by a drop in the restricted method.

The Harvard Injury Control Research Center, which I direct, created a Means Matter campaign to help mental health providers discuss guns with suicidal patients.5 Since most people who die do so on their first suicide attempt and many have never sought treatment, the campaign also provides information to all health professionals who may come into contact with people who may attempt suicide because of other issues (eg, marriage counselors, physicians, and others who provide substance-abuse treatment).

The campaign also reaches out to leaders in the community of people who own guns, including gun shop owners, to promote suicide prevention. The message for gun-owning families is to be alert to signs of crisis and suicidal thoughts among family members. If a family member may be at risk of harming himself or others, take steps to store household guns away from home—temporarily if the crisis is short-lived, or more permanently if the problem becomes chronic—and contact the national suicide hotline to learn other ways to help.

It should be the norm for parents to get guns out of the home when adolescents are potentially suicidal. Like “friends don’t let friends drive drunk,” it should also be the social norm to help a friend going through a rough patch—his wife just divorced him, he’s drinking and talking crazy—by getting the guns out of the house for a while. Had Adam Lanza’s mother received this advice, the 2012 mass shooting by her son of school children and educators in Newtown, Connecticut, might have been prevented.

Reducing Interpersonal Firearm Violence

A key to public health progress in reducing cigarette consumption has been the transformation of smoking from a symbol of modernity, autonomy, power, and sexuality to a symbol of addiction and of weakness. Guns are frequently used in inner-city disputes between youths as a symbol of power and masculinity. Too often, when a young man is “dissed,” the norm requires that he respond violently, sometimes with a gun. A better norm would be that only “wusses” use guns and that hand-to-hand combat or nonviolent resolutions are more manly responses. The current norm is reminiscent of the old dueling norm among high-status whites. Although illegal, for centuries dueling was a common way to resolve disputes. If a man was disrespected and did not duel, he could lose face. Fortunately, the norm has changed—dueling is now considered silly.

Many femicides occur when a woman attempts to end an intimate relationship; her partner shoots her and then shoots himself. Unfortunately, judges issuing restraining orders rarely demand the removal of firearms—even when the woman reports being threatened with a gun. Mothers Against Drunk Driving helped toughen discretionary sentencing norms for drunk-driving convictions simply by attending hearings and informing the judges that drunk drivers—like the one being sentenced—killed their children. Similarly, families of victims killed by the guns of intimate partners should make their presence known when judges are considering gun removal when issuing restraining orders.

Conclusions

Many successes in preventing violence involve changing social norms.6 For example, Sweden changed parental attitudes and practices concerning the corporal punishment of children; child abuse decreased, apparently without an increase in parental permissiveness.7 And a multifaceted US Air Force program lessened the stigma in seeking professional help for mental health problems, reducing suicides, family violence, and homicides.8

To reduce gun violence in the United States, we need many groups (eg, physicians, clergy, women’s groups, gun owners) working to create not only sensible laws and effective enforcement of these laws but also better social norms. Under these improved social norms, all gun owners will be expected to secure their guns responsibly, and gun trafficking, gun suicides, and interpersonal firearm violence will be reduced. The first steps toward achieving change are recognizing the norms that need to be improved and realizing that change is indeed possible.

Miller
M, Azrael
D, Barber
C. Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide. Annu Rev Public Health. 2012;33:393-408.PubMedArticle